| NPI | 1477502342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA OPT8839) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT8839) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2023-04-20 |